Transcript Acute Care Med Rec Connection Call

August 19th Webex
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Review article and discuss strategies for
application of learning
Round table discussion/question list
Jennifer R. Pippins, Tejal K. Gandhi et al, Classifying and Predicting
Errors of Inpatient Medication Reconciliation, Journal of General
Internal Medicine, Springer New York, Vol. 23, No. 9, 1414-1422,
September 2008.
Objective: To determine the reasons, timing and predictors of potentially
harmful medication discrepancies
Design: Prospective observational study
Patients: Brigham and Women’s Hospital admitted general medical patients
Measurements:
Study pharmacists took gold-standard medication histories and compared
them with medical team’s medication histories, admission and discharge
orders. Blinded teams of physicians adjudicated on all unexplained
discrepancies
Results :
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Among 180 patients, 2066 medication discrepancies were identified, and 257
(12%) were unintentional and had potential for harm (1.4 per patient).
Of these, 186 (72%) were due to errors taking the preadmission medication
history, while 68 (26%) were due to errors reconciling the medication history with
discharge orders.
Most PADEs occurred at discharge (75%).
In multivariable analyses, low patient understanding of preadmission medications,
number of medication changes from preadmission to discharge, and medication
history taken by an intern were associated with PADEs.
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Conclusions : Unintentional medication discrepancies are common and more often
due to errors taking an accurate medication history than errors reconciling this
history with patient orders. Focusing on accurate medication histories, on
potential medication errors at discharge, and on identifying high-risk patients for
more intensive interventions may improve medication safety during and after
hospitalization.
Journal Link:
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http://psnet.ahrq.gov/resource.aspx?resourceID=7896&sourceID=1&emailID=84
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Training for medication history taking
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Get it right at admission reliably
◦ Do you have a check system to determine if BPMH’s are
gold standard?
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Develop ways to illicit all medications.
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Incorporate strategies for low literacy patients
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Make medication changes visible throughout
various transitions
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Poll
Share comments,
Your experience with BPMH training
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https://communities.saferhealthcar
enow.ca/medrec?go=1514513
Addendum History
Form (used for
medications left off
BPMH)
Redundancy provision
to ensure all
medications are
captured on BPMH
Create secondary ways
to capture missed meds
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https://communities.saferhealthcar
enow.ca/medrec?go=1422706
Patient Home
Medication Record Includes Admission,
Transfer and Discharge
Ensure medications
visible in one place for
all transitions
Visible medication changes
throughout transitions
https://communities.saferhealthcar
enow.ca/medrec?go=z1110065
Create tools for patients
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https://communities.saferhealthcar
enow.ca/medrec?go=1680807
Orientation checklist
for training
Use Pharmacy Techs
for obtaining BPMH
Use DVD training
videos
Use prompts for
different questions on
BPMH forms
Standardize training
VIHA Picture tool with tips
https://communities.saferhealthcar
enow.ca/medrec?go=1829493
Use of pictures for low literacy
Reminders & tips for improved BPMH
Your questions & comments